GEN. VI. Erythema. Inflammatory blush. Illustrated. irritated, notwithstanding that the irritated part evinces, GEN. VI. SPEC. I. General character. SPECIES I. ERYTHEMA CEDEMATOSUM. Edematous Erythema. COLOUR SCARLET; SPREADING WIDELY AND DEEPLY THIS is the "edematous inflammation" of Mr. Hunter, who observes that, when the extravasated fluid is water, it has very much the appearance of the adhesive inflammation, and probably resembles it more nearly than any other erythema, being of a scarlet colour, but much more diffused. The skin, through the whole range of the intumescence, appears glabrous, and the redness vanishes upon a pressure of the finger, but returns as soon as the pressure is removed. The extravasated fluid is principally serum, and hence the swelling spreads wider than the inflammation itself. It is very painful, or, rather, very sore, but has less of the sensation of throbbing than the adhesive inflammation. It is apparently limited to the surface, yet it probably goes much deeper: for SPEC. I. Erythema sum. than the surface. Habit often dropsical. the extravasated fluid is in too large a quantity to be GEN. VI. furnished by the cells of the cutis alone: but as the swelling and the inflammation do not here keep pace œdematowith each other as in the adhesive description, we have Edematous not the same guide to direct our judgement. Coincidently erythema. with the remarks already offered, Mr. Hunter observes Probably that "the difference between this and the adhesive in- goes deeper flammation arises, I conceive, from the principle of inflammation acting upon a dropsical disposition, which is always attended with weakness; whereas a greater degree of strength would have produced the adhesive inflammation under the same cause or irritation. And what makes me conceive this, is, that in many cases of anasarcous legs we have exactly this inflammation come on from distention, which adds to the extravasation of the serum, as well as in most cases of scarifications of edematous parts to evacuate the water. When this in- Inflammaflammation takes place it is much more lasting than the adhesive; and I believe, seldom or never produces sup- the adhepuration but if it should run into this stage, it is more Sometimes general, and the whole cellular membrane in the inter- suppurates, stices of parts is apt to mortify and slough, producing spreads widely, and very extensive abscesses, which are not circumscribed." becomes There is no difficulty in determining why edematous gangrenous. inflammation should rarely, if ever, produce suppuration, matous inWhy edeand why it should be of longer continuance. Suppurative flammation inflammation is, generally speaking, the process of a healthy part or habit taking place instinctively for the purpose of removing something that is dead, irritating, or otherwise mischievous, and of filling up the space hereby produced with sound living matter. In edematous inflammation the part or habit is unhealthy, and debilitated; and hence, while there is necessarily less tendency to suppuration, there is less power of recovery. ⚫tion more lasting than sive. rarely sup purates. In some instances intumescence is migratory, of which Sometimes Dr. Swediaur gives a singular case that had just occurred migratory. in his practice. The patient was a robust, sanguineous GEN. VI. SPEC. I. Erythema œdemato sum. Edematous erythema. Curative in tention. man of fifty five years of age, who had for many years laboured under paroxysms of gout which had returned after certain intervals, but who, at the time, had been free from attack for a longer term than usual. The edema first suddenly showed itself in the eye-lids, and disappeared on the second day, when he complained of pain and swelling in the fauces with difficult deglutition. This was removed by astringent gargles, when the eyelids became again edematous; then the neck, and in a few days, in succession, the fingers of the right hand; the fingers itched, became exulcerated, discharged an acrid humour, and the patient felt well. Some months afterwards the same erythema returned, travelled in the same direction, and at last fixed on the feet, which in like manner inflamed, ulcerated, and healed with a speedy return of general salubrity *. The general curative intention therefore may be expressed in a few words. It should consist in whatever has a fair promise of giving local or constitutional tone, or both. Hence the benefit of astringent epithems and lotions whether formed of earths, acids, or metallic oxydes, applied to the part affected; and of stimulants where the action is peculiarly weak, as camphor-water, or a solution of the acetate of ammonia, with proof spirit proportioned to the degree of torpor. And hence, as internal medicines, bark, columbo, myrrh, iron, will often be found highly serviceable, in conjunction with a generous diet, pure air, and such exercise as may be taken without fatigue. * Nov. Nosol. Meth. Syst. Vol. 11. 142. SPECIES II. ERYTHEMA ERYSIPELATOSUM. Erysipelatous Erythema. COLOUR DEEPISH-RED; SUPERFICIAL; WITH A DETER- SPEC. 11. affects the cellular THIS is the "erysipelatous inflammation" of Mr. Hun- GEN. VI. ter; and is evidently that which symptomatically accompanies the erysipelas as an exanthem, or eruptive fever. It is more commonly cutaneous than situated in the Commonly deeper-seated parts; although in some constitutions al- cutaneous: most every inflammation, wherever it takes place, will run deep as well as wide. The skin, however, appears to be most susceptible of its action; for it will spread over a prodigious surface of skin, while it rarely affects and rarely even the cellular membrane underneath; and in this respect, especially, it differs from the preceding species. membrane. The extravasation moreover is less than either in the edematous or even the adhesive inflammation. It ap- Supports itself by pears to support itself by continued sympathy; for it commonly begins at a point, and spreads in a migratory sympathy, direction, as the part first attacked recovers. This can- first attackthe parts not, therefore, be merely constitutional; for, if it were, ed soon the parts already inflamed could not recover, while the recovering: morbid condition of the constitution disposes the surrounding parts to the same action; but it affords an idea that, when the parts affected have once gone through the action, they lose the morbid disposition and become disease. healthy. This property is not peculiar to the inflam continued and losing the morbid predisposion by the action of the GEN. VI. SPEC. II. Erythema erysipelato sum. Erysipela tous erythema. Other examples of the same. More frequent in mation before us; the ring-worm and many other cutaneous affections have the same tendency. Mr. Hunter observes that this inflammation is more common in the summer than in the winter, especially in hospitals; and believes that it takes place more frequently after wounds on the head than any where else. "I have often", says he, "seen it begin round a wound on the scalp, and extend over the whole head and face: the eye-lids being very much swelled and the ears thickened; it has then advanced to the neck, shoulders, and body, creeping along both arms, and terminating at the fingers' ends the part which attacks the body often descends to wounds on both thighs, passes down the legs, and terminates at the ends of the toes. And while this is going on, it is as expeditiously cured behind, and the skin peels off from the cured parts." Sometimes, however, it stops sudwhole body. denly in its course, and assumes a milder character. summer than in winter: more com mon after the head than elsewhere; migrates over the Sometimes stops abruptly. If it reach the cellular membrane it suppurates; forming the erysipe las phlegmonodes of Galen. Gives a peculiar sen sation to the touch. Effusion should be soon evacuated. If it proceed deeper than the skin into the cellular membrane, it often suppurates, and at times occasions mortification in the cells by which air is let loose; and it is this state of the disease that forms the erysipelas phlegmonodes of Galen *, Van Swieten †, and many later writers, who have used erysipelas in the loose manner I have already pointed out, as synonymous with erythema. The effect of this mixture of inflammations produces a strange feel, for it is neither that of fluctuation nor of crepitation; and as there are no adhesions, the matter finds an easy passage into the common cellular membrane, increasing the same kind of suppuration wherever it goes; and as mortification, and consequently putrefaction, follow speedily, the discharge becomes very offensive. As the parts loaded with effusion seldom ulcerate, they should be opened early; for the fluid either gets into the cellular membrane from the want of adhesions, or separates parts that are only attached, as the periosteum from the bone, or muscles from muscles; while the true suppurative inflammation, on the con • Mat. Med. Lib. xiv. eap. 11. + Comment. Tom. 1. § 723 |